Provider Demographics
NPI:1306878517
Name:MORRIS, JOHN R (ATC/L)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:MORRIS
Suffix:
Gender:M
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 SCOOTER DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32408-5557
Mailing Address - Country:US
Mailing Address - Phone:850-230-3716
Mailing Address - Fax:850-230-2344
Practice Address - Street 1:210 SCOOTER DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32408-5557
Practice Address - Country:US
Practice Address - Phone:850-230-3716
Practice Address - Fax:850-230-2344
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00914172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver